Cold Chain

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Cold Chain

• Surveillance Coordinator
• Provincial EPI cell

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What is cold chain system

• From the manufacture to the recipient, all the
  steps n people involved in keeping the vaccine in
  the required temperature is called the cold chain
  system

3
The cold chain

• Vaccines are sensitive biological.
• Needs special attention.
• Damages by heat freezing.
• Once potency is lost cannot be regained.
• Requires special storage mechanism.
• From manufacturer to site of use.
• Two major factors.
• Staff
• Equipment

4
Current vaccine management system
5
EPI cold rooms

• Peshawar.
• Malakand.
• Mansehra.
• Kohat.
• Bannu.
• D.I.Khan.

6
Location of cold rooms
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Vaccine storage

• Ideal temperature (2 to 8 ) so that pneumococcal,
  penta TT do not freeze
• Polio if needed to be stored for more then 3
  months can be stored in 20.
• Thermometers
• Dial, cold chain monitor card, mercury
• VVM, Shake test

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Conclusion.

• Good installations are available.
• Have trained staff posted.
• Have the vaccine storage capacity for entire
  divisions.
• Working back up is available in most of the cold
  rooms.
• Stock registered are maintained.

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Conclusion-2

• Cold rooms remained out of order for considerable
  time.
• No mechanism for local repair.
• No allocation for POL of generators.
• Did not serve during the past 2 years.
• No proper supervision mechanism of concerned
  staff.
• No leave account maintained.
• No written job description of staff.
• Not trained on storekeeping.

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Conclusion-3

• No procedures for
• Receiving vaccines.
• Issuing vaccines. (vit A during NIDs)
• No proper vaccine management system. (Frequency
  quantity of vaccine)
• Vaccine is collected from provincial cold room
  instead of divisional.
• Divisional cold rooms are under utilized.
• No allocation for maintenance and repair.

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Suggestions

• Much more is desired to be done.
• Vaccine management system.
• Date of collection vaccine stock at different
  levels.
• Regular review/signing of stock registers.
• Mechanism for monitoring of the system.
• Development of SOPs for various tasks.
• Using checklists for various occasions.

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Suggestions-2

• Ensuring vaccine stock at every level.
• Collection of vaccine from divisional, instead of
  provincial cold room.
• Allocation of maintenance and repair funds beyond
  the PC-1 period.
• POL issue for generators to be taken.

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Suggestions-3

• Training of personnel on storekeeping practices.
• Installation of automatic temperature recording
  equipment.
• Developing mechanism for utilization of technical
  staff.
• Provincial cell should deliver vaccine to cold
  rooms.

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Proposed vaccine management system

• Vaccine should be collected from federal cell on
  quarterly basis.
• Provincial store to supply vaccine to cold rooms.
• Divisional cold room have 3 months quota.
• Districts will collect vaccine from divisional
  cold rooms.
• District stores 2 months supply.
• EPI centers 1 month stock.

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Checklist for receiving vaccine

• When Vaccine Consignments Arrive at the Storage
  Point
• All details of the consignment must be checked.
• All detail be recorded in the stock register.
• District
• Name of cold room/store/health facility
• Name of storekeeper/worker
• Designation
• The type of vaccine
• The quantity received (in doses)
• The vaccine manufacturer
• The batch or lot number.
• The expiry date.
• The status of the VVM
• Balance

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Issuing vaccine

• Record of each consignment leaving the store is
  appropriate.
• All details should be recorded.
• The quantity issued.
• Batch number.
• Expiry dates .
• To whom issued.
• The remaining balance.

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While vaccine is in storage

• All vaccines must be systematically arranged .
• Older stock should normally be distributed first.
  (FIFO).
• Expiry must be checked regularly.
• All stocks must be distributed well before their
  expiry date.
• Ensure that no batch or lot remains too long in
  storage.
• Regularly check the integrity of the stocks by
  reviewing the status of VVM.
• Any expired, damaged or vials with VVMs beyond
  the discard point should not appear in the stock
  balance.

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• Vaccine demand
• Requirement/Target.
• Vaccine in balance.
• Consumption in previous month (s)
• Vaccine received in previous month.
• Vaccine issued.
• Vaccination coverage.

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• Thank you